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September 11 - 21, 2026</div></div>
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<form class="userform-form" action="" method="post" name="form_6075901" id="6075901" accept-charset="utf-8"><input type="hidden" name="formID" value="6075901" /><div class="form-all dir_ltr" dir="ltr"><ul class="form-section"><li class="form-line" id="id_1"><div class="form-label-left" id="label_1"><label for="input_1"> Full Name<span class="form-required">*</span> </label><label class="label-message" for="input_1"> </label></div><div id="cid_1" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q1_fullName[first]" id="first_1" autocomplete="given-name" />  <label class="form-sub-label" for="first_1" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q1_fullName[last]" id="last_1" autocomplete="family-name" />  <label class="form-sub-label" for="last_1" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_8"><div class="form-label-left" id="label_8"><label for="input_8"> E-mail<span class="form-required">*</span> </label><label class="label-message" for="input_8"> </label></div><div id="cid_8" class="form-input"> <input type="email" class=" form-textbox validate[required, Email]" id="input_8" name="q8_email" size="30" value="" autocomplete="email" /> </div></li><li class="form-line" id="id_3"><div class="form-label-left" id="label_3"><label for="input_3"> Number of Attendees<span class="form-required">*</span> </label><label class="label-message" for="input_3"> </label></div><div id="cid_3" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_3" name="q3_number" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li class="form-line" id="id_4"><div class="form-label-left" id="label_4"><label for="input_4"> Please select all that apply<span class="form-required">*</span> </label><label class="label-message" for="input_4"> </label></div><div id="cid_4" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_4_0" name="q4_input4[]" value="Rosh Hashana Day 1" /><label id="label_input_4_0" for="input_4_0"><span>Rosh Hashana Day 1</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_4_1" name="q4_input4[]" value="Rosh Hashana Day 2" /><label id="label_input_4_1" for="input_4_1"><span>Rosh Hashana Day 2</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_4_2" name="q4_input4[]" value="Yom Kippur Kol Nidrei" /><label id="label_input_4_2" for="input_4_2"><span>Yom Kippur Kol Nidrei</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_4_3" name="q4_input4[]" value="Yom Kippur Day" /><label id="label_input_4_3" for="input_4_3"><span>Yom Kippur Day</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_6"><div id="cid_6" class="form-input-wide"> <div id="text_6" class="form-html"><p>At Chabad Dingley everyone is welcome. </p>

<p>We don't charge for our services but donations are appreciated!</p>
</div> </div></li><li class="form-line" id="id_5"><div class="form-label-left" id="label_5"><label for="input_5">  </label><label class="label-message" for="input_5"> </label></div><div id="cid_5" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_5_0" name="q5_input5[]" value="Yes, I would Like to Donate!" /><label id="label_input_5_0" for="input_5_0"><span>Yes, I would Like to Donate!</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_7"><div class="form-label-left" id="label_7"><label for="input_7"> Payment </label><label class="label-message" for="input_7"> </label></div><div id="cid_7" class="form-input"> <table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2" class="form-payment-methods form-multiple-column"><span class="form-radio-item"><input class="paymentMethod form-radio validate[paymentMethod] form-radio" type="radio" id="input_7_creditCard" name="q7_payment[payment_method]" value="creditCard" onclick="BuildSource.creditCard(this)" /><label for="input_7_creditCard">Credit Card</label> </span><span class="form-radio-item"><input class="paymentMethod form-radio validate[paymentMethod] form-radio" type="radio" id="input_7_other" name="q7_payment[payment_method]" value="other" onclick="BuildSource.other(this)" /><label for="input_7_other">Bank Transfer</label> </span></td></tr><tr class="credit_card hide"><th colspan="2">Credit Card</th></tr><tr class="credit_card hide"><td colspan="2" style="padding:0"><table cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2"><span class="form-sub-label-container">  <label class="form-sub-label">We accept Visa, MasterCard, American Express</label></span><div class="cc-icons"><div class="cc-icon visa-icon"></div><div class="cc-icon mastercard-icon"></div><div class="cc-icon amex-icon"></div></div><input type="hidden" name="q7_payment[cc_type]" id="input_7_cc_type" value="" /></td></tr><tr><td><div class="cc-field-wrapper"><span class="form-sub-label-container"><input class="form-textbox form-creditcard js-cc-number validate[visible, creditcard]" type="text" name="q7_payment[cc_number]" id="input_7_cc_number" autocomplete="cc-number" size="20" />  <label class="form-sub-label" for="input_7_cc_number" id="sublabel_cc_number">Credit Card Number</label></span></div></td><td class="cc_ccv "><span class="form-sub-label-container"><input class="form-textbox validate[visible]" type="text" name="q7_payment[cc_ccv]" id="input_7_cc_ccv" autocomplete="cc-csc" size="6" />  <label class="form-sub-label" for="input_7_cc_ccv" id="sublabel_cc_ccv">Security Code</label></span></td></tr><tr class="credit_card hide"><td colspan=""><span class="form-sub-label-container"><select class="form-textbox validate[visible]" name="q7_payment[cc_exp_month]" id="input_7_cc_exp_month" autocomplete="cc-exp-month"><option></option><option value="1">1 - January</option><option value="2">2 - February</option><option value="3">3 - March</option><option value="4">4 - April</option><option value="5">5 - May</option><option value="6">6 - June</option><option value="7">7 - July</option><option value="8">8 - August</option><option value="9">9 - September</option><option value="10">10 - October</option><option value="11">11 - November</option><option value="12">12 - December</option></select>  <label class="form-sub-label" for="input_7_cc_exp_month" id="sublabel_cc_exp_month">Expiration Month</label></span></td><td><span class="form-sub-label-container"><select class="form-textbox validate[visible]" name="q7_payment[cc_exp_year]" id="input_7_cc_exp_year" autocomplete="cc-exp-year"><option></option><option value="2025">2025</option><option value="2026">2026</option><option value="2027">2027</option><option value="2028">2028</option><option value="2029">2029</option><option value="2030">2030</option><option value="2031">2031</option><option value="2032">2032</option><option value="2033">2033</option><option value="2034">2034</option></select>  <label class="form-sub-label" for="input_7_cc_exp_year" id="sublabel_cc_exp_year">Expiration Year</label></span></td></tr></tbody></table></td></tr><tr class="other hide"><td colspan="2">Chabad SEM Benevolent Inc<br />BSB: 033-180<br />Account: 346340</td></tr></tbody></table> </div></li><li class="form-line" id="id_9"><div class="form-label-left" id="label_9"><label for="input_9">  </label><label class="label-message" for="input_9"> </label></div><div id="cid_9" class="form-input"> <div class="form-multiple-column" data-columns="3"><span class="form-radio-item"><input type="radio" class="form-radio" id="input_9_0" name="q9_input9" value="180" /><label for="input_9_0"><span>$180 AUD</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio" id="input_9_1" name="q9_input9" value="360" /><label for="input_9_1"><span>$360 AUD</span></label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio" id="input_9_2" name="q9_input9" value="540" /><label for="input_9_2"><span>$540 AUD</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_9_3" name="q9_input9" value="720" /><label for="input_9_3"><span>$720 AUD</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio-other form-radio" name="q9_input9" id="other_9" value="" /><span><input type="number" min="1" class="form-radio-other-input form-textbox" onkeypress="validateNumber(event)" name="q9_input9[other]" data-otherhint="Other" size="15" id="input_9" disabled="disabled" /></span><br /></span></div> </div></li><li class="form-line" id="id_2"><div id="cid_2" class="form-input-wide"> <div style="text-align: center; text-indent:156px;" class="form-buttons-wrapper button-align-auto"><button id="input_2" type="submit" class="form-submit-button  form-submit-button-none;">Submit</button></div> </div></li><li style="display:none">Should be Empty: <input type="text" name="website" value="" /></li></ul></div><input type="hidden" id="simple_spc" name="simple_spc" value="6075901" /><script type="text/javascript">document.getElementById("si"+"mple"+"_spc").value = "6075901-6075901";</script><div>


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